It is old news that dysfunctional or insecure relationships in childhood may lead to difficulties down the line. Whilst this has long been known, a recent study has shed further light on the reasons for this, and the specific effects poor attachments may have.

Attachments are the relationships we have with caregivers from an early age. In general, attachment styles may be divided into four categories: secure, anxious-preoccupied, dismissive-avoidant and fearful-avoidant. The type of attachment style we develop is directly linked to the quality of care we receive. For example, a neglectful parent may contribute to their child’s dismissive- avoidant attachment style (Cassidy, 1999).

Insecure attachment styles have been linked to range of adult mental health issues. These range from anxiety and depression to relationship issues and even health problems. Obviously attachment styles are an important research area, but why does the human brain react so negatively to poor parenting?

New Developments

The study, published in Frontiers in Human Neuroscience, found that insecure childhood attachments can negatively influence our ability to deal with stress as adults (Leyh, 2016). We are all aware that there is huge variability in how individuals deal with stress. This is evident in any office in the world! Some people remain calm and proactive in the face of adversity, whilst some crumble and become extremely negative.

One of the reasons for this, according to Dr. Rainer Leyh and his team, is that our negative childhood experiences and attachment styles stay with us throughout adulthood, and rear their heads when we are faced with a stressful or anxiety provoking scenario.

Inthis report on the study, Dr Christine Heinsich gives the example of a car approaching a traffic light. For the driver, when they are in a neutral state, following the signal is easy and may even come automatically. For an emotional driver however, following the signal is much more difficult. They may stop late or fail to stop altogether, driving straight through the light.

What moderates our ability to stay calm under emotional strain? For those of us that had emotionally attentive parents or caregivers it can be a lot easier. The key term is “emotional regulation”. Emotional Regulation is our ability to control our emotions, and our reactions and subsequent behaviours in response to them. Attachment styles have been directly linked to emotional regulation.

In the aforementioned study, adults were recruited who had a wide range of childhood parental/ caregiver experiences. Participants were asked to perform a task which involved identifying a target letter from a series of flashing letters. The task was conducted in different conditions, some which evoked a positive emotional response, some which evoked a negative response and others which evoked neutral. The participants’ brain activity was recorded using a type of brain scanning called “EEG”.

Subjects with insecure childhood attachments had significantly more trouble performing under the negative conditions than those with secure childhood attachments. Another interesting finding was that those with insecure attachments also exhibited lower brain activity under negative conditions when attempting to identify the target letter.

The poorer the task performance, the poorer the strategies for emotional regulation. One theory put forth by the researchers, is that the more effort you have to exert on inhibiting your emotion, the less resources you have to perform on the task. Therefore, negative childhood experiences may make all those day- to- day struggles we encounter just that little bit more difficult.

Were there any potential limitations to this study? It could be argued that as the target letters were unrelated to the emotional cures, it is difficult to generalise them to everyday life. Future studies will have to find a way to make the testing environment more realistic.

Despite this, it does see clear that poor relationships with our caregivers can have long- lasting consequences.

How do I know if I have difficulties with attachment and/ or emotional regulation?

It can be difficult to know whether any of this applies to you. You may have difficulties with emotional regulation if:

You have difficulty identifying your own emotions

You have difficulties identifying others emotions

You find it difficult to soothe yourself (make yourself feel better) or others

You have little self-control

Implications for relationships

Those who are negatively attached may bring these issues and insecurities into relationships. Attachment style can have massive connotations, particularly for romantic relationships, and it is important to be aware of how it can affect you. ​It is easy to see the connection between a turbulent relationship, and the findings of the study we have just discussed. Being resilient and calm when faced with stressful situations, arguments and all that comes with a relationship, is often central to its success. For those with poor emotional regulation, this can be difficult.

What can you do about insecure attachment?

Familiarise yourself with your attachment pattern and read up on the theory behind it. This will better equip you to identify maladaptive behaviour.

Find a therapist with expertise in attachment theory. This is an obvious one, but for those with insecure attachment styles, there can be a number of issues that need to be explored.

If attachment style is affecting your love- life, it may help to consider couples therapy. The safe environment of the therapist’s office is a good place to explore the insecurities you have. This is particularly true if your partner is also insecure!

New research is increasingly shedding light on how our past experiences can shape our present and future. It is fascinating what we area learning, but also important to stress that your past does not necessarily dictate your future, and we all have the ability to change long- learned behaviours.

We all know individuals who are of a more melancholy disposition than others. In A. A. Milne’s popular set of children’s stories, the friends of Winnie-the-Pooh include both Tigger – the bouncing, happy tiger; and Eeyore – the somber, plodding donkey. Even from a young age, we all understand that it is completely acceptable for individuals to have their own unique dispositions and levels of emotional valence.​However, when a friend or loved one’s general tendency towards being blue seems to worsen, and perhaps begins to impair day-to-day functioning, it is exceptionally difficult to assess the seriousness and potential danger of the situation. In particular, it can be hard to know when a period of melancholy crosses the line into untreated major depression.

Depression Can Be Misdiagnosed

A recent study published in the JAMA Internal Medicine journal by the American Medical Association indicated that in the United States, a large proportion of individuals seeking attention for depression-related symptoms are misdiagnosed. The study surveyed over 46,000 US adults aged 18 or older in 2012-2013.

Using an established scale to measure depressive symptoms, the study established that around 8.4% of the participants in the sample had depression. However, only 28.7% of those individuals had received treatment. Meanwhile, of those who were undergoing treatment for depression (either psychotherapy or antidepressant medication), only 29.9% screened positive for symptoms of major depression.

This means that there are some serious challenges associated with the correct identification of depression, and diagnosis and treatment is not necessarily always straightforward.

In an effort to widen the scope of research into the prevalence of depression misdiagnosis, another study conducted a meta-analysis of 118 different studies assessing the accuracy of depression diagnoses. The final analysis contained data from more than 50,000 patients across 41 different studies, in countries including the United States, Canada, and various European countries, among others.

In the end, the study suggested that for every 100 cases of potential depression seen by a primary care physician, 15 cases are false positives (treatment was prescribed when there was no real depression), 10 cases are missed (treatment is not prescribed when there is real depression), and 10 cases are correctly identified (treatment is provided for real, identified depression).

One reason for this pattern of diagnosis is the difficulty in ascertaining the difference between depression and psychological distress. The AMA study described in the previous section measured the difference between depression and serious psychological distress, and found that among adults who were undergoing treatment for major depression, 29.9% had depression and 21.8% had serious psychological distress.​In addition, factors such as age, culture, and available medical resources can impact diagnoses. In general, the studies concluded that developing a relationship with a mental health care professional and undergoing multiple diagnostic visits over a longer period of time can substantially increase diagnostic accuracy.

Signs to Look For

To address the complexity of depression diagnosis, there are several mnemonics that have been developed in an effort to make the symptoms of depression more memorable. The mnemonic below, published by Blenkiron, 2006, lists 10 symptoms of depression aligning with the 10 letters of the word. Here we present the list and supplement each item with a brief description.

D = Depressed mood

Depressed mood is a feeling of sadness or negative affect that sustains throughout the day. It is generally worse in the mornings.

E = Energy loss/fatigue

In major depression, the feeling of low energy or physical fatigue will occur almost every day. It’s also important to note that real, inexplicable physical symptoms such as back pain or headaches are commonly reported.

P = Pleasure lost

Also called anhedonia, this loss of pleasure refers to a marked decrease in the level of interest or pleasure one takes in daily activities which repeats for a sustained period of multiple days.

R = Retardation or excitation

The word “retardation” here refers to a slowing down of thinking, speaking, or movement. Alternatively, with major depression there can be a feeling of mania. This can include angry outbursts, anxiety or restlessness, or general agitation.

E = Eating changed—appetite/weight

Changes in eating can fall along opposite extremes in major depression: In many cases, individuals report decreases in appetite and weight loss, but food cravings and weight gain are also reported.

S = Sleep changed

Similarly, changes in sleep can fall on opposite sides of the spectrum. Both insomnia (lack of sleep) and hypersomnia (sleeping too much) are commonly reported, occurring over a period of multiple days.

S = Suicidal thoughts

This symptom of suicidal ideation – often the most alarming for friends and loved ones – can also be the most misunderstood. To be an indicator of major depression, thoughts about death or suicide must recur for a period of multiple days, not simply a single off-the-cuff remark or a joke made in poor taste.

I = I'm a failure (loss of confidence)

When feelings of failure or fixations on past failures increase in frequency for a period of multiple days, this becomes a possible indicator of major depression.

O = Only me to blame (guilt)

Underlying the persistent feelings of guilt that are symptomatic of major depression is a general feeling of worthlessness. Individuals with major depression may assign themselves blame for something that is not their responsibility at all. This must occur nearly every day for multiple days to indicate depression.

N = No concentration

Individuals often report an indecisiveness and a lack of mental clarity that keeps them from attending to and remembering the events occurring around them. When this lack of concentration repeats over a period of multiple days it can indicate the potential for major depression

As was apparent from the list above, each symptom presented must recur in an individual for a period of multiple days before it should be considered a possible indicator for major depression. Generally speaking, until multiple of the symptoms above are present much of the time for a sustained period lasting around two weeks, there should not be major cause for concern.​However, anyone with any concern over the mental health or safety of a friend or loved one should consult with a mental health professional. Individuals who fear for anyone’s immediate safety should contact emergency services.

In our increasingly digital age, addiction to internet use is growing in prevalence, and has recently received more and more attention from medical and scientific researchers. Nowhere is the problem more alarming than with adolescents, who have the greatest access to internet-based technologies, and also have the most at stake developmentally.​Some rather sensationalized news sources have even referred to the rise of internet addiction as a new “electric heroin,” citing the research demonstrating how internet use and serious substance abuse demonstrate similarities in their symptomologies and in the way that they stimulate the reward pathways of the brain.

While the danger and addictive potential of heroin use makes the comparison a little strained, excessive internet use is nonetheless a condition that merits serious attention.

The History Of Internet Addiction

The possibility for addictive behavior related to internet use was first proposed in 1995. The term was initially used in jest, because at the time the rarity of personal computers and the unlikelihood of any individual developing an addiction to internet use made the idea ridiculous.​In the ensuing years, however, the explosion of internet technologies rapidly made internet addiction a reality. By 1998 a diagnostic tool known as the Internet Addiction Tool (IAT) was developed by Dr. Kimberly Young in order to assess whether an individual’s internet use was pathological.

The assessment was based on the criteria for pathological gambling listed in the DSM-IV (the American Psychological Association’s diagnostic manual for mental disorders). This was based on the logic that despite the fact that internet addiction had not yet been recognized by the psychological establishment as a real disorder, the symptoms it presented were similar enough to gambling addiction that the two could be diagnosed in a comparable fashion. When the DSM-V was released in 2013, pathological gambling was updated to a condition now called “gambling disorder,” but problem internet use was once again left out.

Notwithstanding, psychological and medical researchers across the world have begun devoting major resources towards studying the effects of internet use, especially on school age populations ranging from ages 5-22. This field of research has been especially active in Asian countries such as China, Japan, Korea, and Taiwan; countries in which the vast majority of the population have access to the internet and incidence of internet addiction is especially high. Recent studies have found that an estimated 19.8% of adolescents in Taiwan and 20% of adolescents in Korea screened positive for either internet addiction or excessive internet use.

The Diverse Manifestations of Excessive Internet Use

Internet Addiction has been grossly understudied, and additional research is required to establish prevalence rates in European and North American countries. The various diagnostic tools currently available are often times outdated, and assess patterns of internet use that are no longer relevant. Future research is needed to validate measuring tools that more accurately reflect the actual patterns of internet use in today’s adolescents. ​In the 1990s, the internet functions available to the average user were so limited that one of the only possible types of pathological use was compulsively checking websites, in a pattern that closely mirrored compulsive gambling. However, today’s adolescents use the internet for so many different things that, depending on their pattern of use, the internet can either enable or catalyze a host of different disordered patterns of thinking.

For example, online gaming can be associated with the impulsivity often marked in cases of Attention Deficit Hyperactivity Disorder (ADHD). Adolescents with a bent towards narcissistic personality disorder might gravitate towards excessive self-promotion on networking outlets like Twitter, Facebook, or Instagram. The constant stream of world news and cultural information present on social media websites can enable a crippling fear of missing out (or “FOMO”) that might co-occur with an anxiety disorder. And the internet also provides opportunities for the destructive cyber-bullying perpetuated by over-aggressive adolescents.

Of course it is impossible to determine if the disordered or problematic patterns of thinking listed above are caused by internet use or if the internet use simply enables preexisting pathological tendencies to manifest. It is also possible that there is a reciprocal relationship, with excessive internet use both fostering and enabling the expression of negative behavior patterns.

Diagnosis and Understanding

While this diversity of the symptomology of internet addiction makes it difficult to issue blanket statements, the important thing is to have the discernment to distinguish between frequent internet use and the excessive patterns of use that can lead to addiction.​Internet use should not be judged to be excessive until several of the following criteria are met (among others): impaired psychological well-being; worsened academic performance; physical abnormalities including back pain, eye strain or carpal tunnel syndrome; severely decreased family and peer interactions; and finally the traditional markers of addiction, including increased tolerance, signs of withdrawal after lack of use, disregard for consequences, and difficulty controlling behavior.

While discussions of internet addiction can often alarm parents who may believe that their child spends too much time online, it’s important not to jump to conclusions nor to inhibit overall internet use wholesale. Internet use is not per se harmful or inhibiting; in fact, there is a mountain of evidence that adolescents with regular internet access generally have higher test scores, a greater motivation to learn, greater access to health information, and a general feeling of empowerment compared to adolescents without internet access.

As was noted above, there are many diverse uses for internet technologies, and each has the potential to enable various different disordered patterns of thinking. What is required in such a complex situation is a sensitivity to the overall developmental context of an adolescent’s physical, emotional, and social situation.

While internet addiction has recently been given increasing attention by mental health professionals and should be taken seriously, parents of adolescents should not jump to conclusions. Using the criteria listed above, in addition to outside research and, if necessary, consultation with a certified health professional, parents of adolescents can be more secure in their ability to discern between the excessive internet use that marks internet addiction and the frequent internet use that marks 21st century adolescence.

A personality disorder is defined as an “inner experience” (that is, our personal interpretation and understanding of things that happen, as well as our own thoughts and feelings) that deviates significantly from expectations of our culture (DSM-5). There are a number of types of personality disorders, showing different patterns of that inner experience. One such type is Borderline Personality Disorder (BPD). BPD may be diagnosed when a person shows instability in four key areas:

-Self image: Not having a good grasp of your own identity, having big shifts in your goals and values, or tying your view of yourself strongly to relationships.

-Relationships: Worrying about being abandoned, dramatic shifts in their view of others, or having very intense relationships

-Impulsivity: Engaging in self-damaging behaviour, experiencing suicidal thoughts or actions, or having difficulty controlling anger and other emotions

-Emotions: Reacting strongly to low amounts of stress, having difficulty calming down after intense moods, or feeling a range of emotions more intensely than most.

You may notice that the characteristics above frequently include the words “intense” or “strong”, which is a good way to understand BPD. Someone with BPD is likely to experience their inner world in a very intense way, which then results in more intense relationships and experiences with others.

Receiving a diagnosis of BPD can be a source of anxiety in itself as there is not as much awareness of the condition as other psychological diagnoses such as anxiety or depression. On one hand, there may be some relief in knowing that the intense symptoms someone is feeling has a name, but it also elicits questions about treatment and whether they will ever feel “normal”.

Medication VS. Therapy

While there is no medication to specifically address BPD, prescriptions may be made for specific symptoms such as mood reactivity or anxiety. Therapy is considered particularly important for individuals with BPD. One specific type of therapy that has garnered significant attention for its effective treatment of BPD is known as Dialectical Behavior Therapy (DBT). Generally, BPD symptom severity and risk of suicide are greatest in young adulthood, and then often diminish with age, particularly with therapeutic intervention.

Dialectical Behavior Therapy (DBT)

The word “dialectic” means looking at opposing ideas in order to find the truth. In the case of DBT, this type of therapy aims at broadening our perspectives and developing skills to both accept and regulate our emotions. DBT also places value on developing skills for having healthy relationships. DBT is practiced in both individual therapy and in group sessions. Group sessions follow a particular structure of training skills from four different modules:

Mindfulness- Skills that encourage focus on what is happening in the present. This may involve focussing on physical feelings and identifying emotions and thoughts that are occurring in the moment

Interpersonal Effectiveness: Many people with BPD have good social skills, but often have difficulty applying those in all situations.

Distress Tolerance: With fluctuating emotions, it is impossible to expect that individuals with BPD will no longer feel distress, but rather the focus is on tolerating stressful feelings and becoming more aware of what is happening.

Emotional Regulation: Emotions will continue to come for people with BPD, but DBT teaches strategies for labelling feelings and reducing their influence on actions.

If DBT is started in a structured setting, clients often then continue with individual therapy afterward to continue the skill development and receive effective support.

We can now see narcissism in the brain. Brain scans of people with Narcissistic Personality Disorder (NPD) showed they have less brain matter in areas associated with emotional empathy. This is the first time anyone has seen the evidence of narcissism in brain structures.

The inability to feel empathy is one of the hallmarks of NPD. Researchers have found that people with this disorder can take the perspective of another person in a purely intellectual way. However, when it comes to actually feeling what another person is going through, narcissists have difficulty.

A group of German researchers recently studied the source of this lack of emotional empathy in people with NPD. In their research, they collected MRI brain scans of 17 people with NPD along with 17 people from the community for comparison. The researchers first looked at brain volume overall and found that the people with NPD were similar to the healthy individuals. That is, both groups’ brains’ were similar overall.

The researchers then examined the areas of the brain that are now considered areas associated with empathy (i.e., bilateral anterior insula, anterior and median parts of the cingulate cortex, and the supplementary motor area). They found that the patients with NPD had less brain matter in areas that overlapped with the areas associated with empathy (i.e., left anterior insula, rostral and median cingulate cortex as well as dorsolateral and medial parts of the prefrontal cortex).

Put simply, the empathic areas of the brain were less developed in people with Narcissistic Personality Disorder (NPD).

Narcissistic Personality Disorder affects about 1% of the general population and it has been shown to impair interpersonal functioning. This groundbreaking research will likely help legitimize the disorder and, ironically, help people to empathize with people who are suffering with this illness.

Tickling someone is fun, and it can be fun to tickled (sometimes). So this means that ticklish people are more fun, right?Darwin thought so. He thought comedy and tickling both "tickled the mind." Humorous people laugh because of funny jokes and because someone tickles them. Sounds like a fun person to me.

This year some Swiss researchers actually showed Darwin was wrong. The Swiss discovered, after a few brain scans, that humour and ticklish giggles are actually quite different.

Tickling does cause some of the same regions of the brain to light up as a good joke, but tickling also lights up the hypothalamus. This region regulates a lot of instinctive functions (body temp., hunger etc.). It also activates the anticipation of pain areas of the brain.

These extra areas of activation explain why people act like they are under attack when they are being tickled, and why you might have been kicked or punched when tickling someone. It also begins to explain how being tickled can be painful and make you laugh at the same time.

Tickling, even with all its mixed feelings, does put us in a fun mood. Two researchers from California tickled people before and after a comedy. These tickled individuals were more likely to laugh than people not tickled before the comedy. Not only that, they also laughed more after the comedy when they were tickled. Looks like tickling gets you in the mood for more tickling.

A ticklish person may not be more fun, but tickling does seem to put us in the mood for fun.